P048 Paediatric headache: referral patterns and management within an outpatient tertiary paediatric neurology service

P048 Paediatric headache: referral patterns and management within an outpatient tertiary paediatric neurology service

S36 P048 Paediatric headache: referral patterns and management within an outpatient tertiary paediatric neurology service S. Ray1 *, A. Curran1 , R. K...

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S36 P048 Paediatric headache: referral patterns and management within an outpatient tertiary paediatric neurology service S. Ray1 *, A. Curran1 , R. Kneen1 , R. Kumar1 . 1 Neurology, Alder Hey Children’s NHS Foundation Trust, Liverpool, United Kingdom Objectives: Headache is the referral problem in 25% of children referred to the paediatric neurology outpatient service at our centre. Analysing variations in referral patterns and current management within the service will identify areas for quality improvement. Methods: Retrospective review of 75 consecutive referrals for headache to the outpatient paediatric neurology department at Alder Hey between October 2007 and May 2008. Children were less than 16 years at referral. The referral letters, and hospital notes and clinic letters where available, were analysed against available quality indicators. Results: 75 referral letters were analysed, with clinical notes and letters analysed for 47 children. Referrals were from: general practitioners 82%; ophthalmology 9%; A&E 4%; neurosurgery 3%. Median age of patients was 11 years. Median length of history of headaches prior to referral was 9 months. 41% of referrals were for diagnosis; 56% for further opinion on treatment; and 3% for a second opinion. The frequency of the patient’s headache was not recorded in 24% of clinic letters. 57% of clinic letters did not record headache severity or impact on functioning. Where headache frequency was quantified, the mean frequency of headache was 16 days per month. All children had a primary headache syndrome. Additional pharmacological treatment was initiated or advised in 53%; of these, 57% were for prophylactic treatment. Prophylactic treatments included: pizotifen 8 children; topiramate 4 children; propranolol in 1 child. 24 children (52%) were discharged after first consultation, of whom 2 were re-referred during the study period; 37% had a further appointment; 11% to be arranged following investigations. Discussion: We noted variation in headache management within the paediatric neurology department. Areas for improvement identified include use of indicators of headache impact on functioning. We highlight our increasing use of topiramate relative to propranolol for prophylaxis. P049 Hepatocellular Adenoma associated with long-term exposure to Phenobarbital C. Cerminara1 , V. Bagnolo1 , E. Compagnone1 , F. De Leonardis2 , M. Pinci1 , P. Curatolo1 *. 1 Child Neurology Unit, Department of Neuroscience, “Tor Vergata” University of Rome, Italy; 2 Hepatology Service, Department of Gastroenterology, “Tor Vergata” University of Rome, Italy Objective: We report on a 13-year-old female who developed hepatocellular adenoma associated with long-term exsposure to Phenobarbital after treatment of left frontal arteriovenous malformation (AVM) by radiosurgery with Gamma Knife with Leksell technique. Methods: We performed routinary laboratory tests and then hepatic ultrasound examination and MRI of the upper abdomen. Results: Routine laboratory tests disclosed an elevation of alanine transaminase (45 U/l; N: 0−34 U/l), and gammaglutamyltransferase (85 U/l; N: 5−38 U/l); bilirubin was slight under the normal limit (0.24 mg/dl; N: 0.3−1.2). Hepatic echography revealed a 22 mm hyperechogenous and well-delimited formation, located in the seventh segment and at the first instance interpreted as angioma. MRI confirmed the presence of a smooth edges lesion in correspondence of the same segment (maximum transverse diameter: 23 mm). The contrastographic evaluation (significant enhancement in

Posters the arterial phase and rapid wash-out in the portal phase) excluded the nature of angioma. Conclusions: HA is a rare lesion that occurs predominantly in women, and is associated with oral contraceptives and anabolic steroids. HA has also been reported with other rare associations in children, as glycogen storage disease, severe combined immunodeficiency. Based on available evidence, Phenobarbital is cancerogenic in animal models and possibly cancerogenic to humans. This drug acts as a strong promoter of DNA synthesis and leads to the development of multiple adenoma and carcinomas in the liver of rats and mice. The tumor-promoting action PB was attributed to its effect on gap junction-mediated intercellular communication, by which cells interact with each other and inhibit the growth of surrounding cells. PB was administered to our patient, 75 mg per day for 7 years, and the long-term-use of PB may have persistently induced mild but significant damage to the hapatocytes as well as a continuous regenerative changes of these hepatocytes, resulting in neoplastic transformation. P050 Assessment of socio-psychological determinants of Turkish mothers with cerebral palsied children F. Beydemir1 , U. Cavlak1 *. 1 School of Physical Therapy and Rehabilitation at Pamukkale University, Denizli, Turkey Objective: Mothers having children with disability have to provide most of the care for their children. The aim of this study was to evaluate the impact of having disabled children on Turkish mothers. Methods: Two hundred and forty seven Turkish mothers with cerebral palsied children completed the Turkish version of the Impact on Family Scale, Beck Depression Inventory (BDI), and Nottingham Health Profile (NHP). Mothers from 5 different regions in Turkey who had at least one child with CP and are free from any mental problem were included in the study. Of the mothers 46.2% (n = 114) were in the 28−37 age interval, 64.4% of them had completed primary school, 95.5% were married and living with their husbands, and 93.5% were housewives. Results: Total impact of that fact of disability to the mothers was 57.27±10.08. The four sub parameters, including financial support (9.60±2.29), general impact (30.56±6.29), disruption of social relations (24.42± 4.97), and coping (6.53±2.06) were also computed. The average values for NHP were determined as follows; NHPE: 56.63±36.20; NHPP: 27.44±29.32; NHPER: 46.97±31.79; NHPSI: 36.47±33.18; NHPS: 34.15±29.92; NHPPM: 21.27±18.80; NHP TOT: 271.21±133.68. One hundred and eight mothers (43.7%) scored 17 and over on the BDI. The rest (56.3%) scored 16 and below. That means more or less half of the mothers showed depressive symptoms. Conclusion: The study demonstrated that Turkish mothers with cerebral palsied children were at risk in terms of sociopsychological determinants. Therefore, the mother having a disabled child should also be detected earlier before planning the most suitable rehabilitation program to prevent sociopsychological problems. Reference(s) [1] Cavlak U, Kavlak E, Tarakcı E et al. A comparison of quality of life mothers with children with/without disabilities: a sample based on turkish population. 9th International Conference of Baltıc Child Neurology Association (BCNA) Vilnius, Lithuaia 2007; 1392 3064: 31. [2] Stein RE, Riessman CK. The development of an impact-on-family scale: preliminary findings. Med Care 1980;18(4): 465−72.